Provider Demographics
NPI:1063625515
Name:HOPEWELL CENTER
Entity type:Organization
Organization Name:HOPEWELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-531-1770
Mailing Address - Street 1:218 GREENSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8364
Mailing Address - Country:US
Mailing Address - Phone:636-379-7727
Mailing Address - Fax:
Practice Address - Street 1:4411 N NEWSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2534
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-381-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36874251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO36874OtherR.N.